Group cognitive behavior therapy or social skills training for individuals with a recent onset of psychosis? Results of a randomized controlled trial

Metacognitive training (MCT) for schizophrenia improves cognitive insight: a randomized controlled trial in a Chinese sample with schizophrenia spectrum disorders

Metacognitive training (MCT) is a group-based treatment program for people with schizophrenia that targets the cognitive biases thought to contribute to the pathogenesis and maintenance of delusions. Although effective in reducing the severity of delusions, the influence of MCT on cognitive insight, and its feasibility in Chinese culture, has yet to be investigated. The present randomized-controlled trial attempted to address these inconsistencies. A Chinese sample of 80 participants with schizophrenia spectrum disorders was randomized to the eight-module MCT program or continued treatment as usual (TAU). All participants were assessed using the Beck Cognitive Insight Scale, which assesses two components of cognitive insight (self-reflectiveness and self-certainty). Participants in the MCT condition subjectively rated their satisfaction with the training. Retention rates were high after four-weeks of MCT (n = 38) or TAU (n = 39). Clients randomized into the MCT condition rated the program favourably and showed significant improvements in cognitive insight (i.e., increased self-reflectiveness), relative to TAU controls, who exhibited decreases in cognitive insight at follow-up. These findings suggest that the MCT program is not only subjectively efficacious in Chinese samples, but also improves metacognitive awareness of the processes underlying delusional symptoms.

Merging evidence-based psychosocial interventions in schizophrenia

Psychosocial interventions are an essential part of the treatment for people with severe mental illness such as schizophrenia. The criteria regarding what makes an intervention “evidence-based” along with a current list of evidence-based interventions are presented. Although many evidence-based interventions exist, implementation studies reveal that few, if any, are ever implemented in a given setting. Various theories and approaches have been developed to better understand and overcome implementation obstacles. Among these, merging two evidence-based interventions, or offering an evidence-based intervention within an evidence-based service, are increasingly being reported and studied in the literature. Five such merges are presented, along with their empirical support: cognitive behavior therapy (CBT) with skills training; CBT and family psychoeducation; supported employment (SE) and skills training; SE and cognitive remediation; and SE and CBT.

[Cognitive behavior therapy after first-episodes psychosis]

Cognitive behavior therapy (CBT) is recommended for the treatment of first-episode psychosis (FEP) patients. It can be offered in acute state or during the remission of the episode. Up to date, effects of CBT have been examined in several controlled and randomized trials in FEP. Combined with antipsychotic medications, results have demonstrated that CBT decreases positive psychotic symptoms, enhances quality of live, self-esteem and insight, and diminishes the intensity of comorbide symptoms, such as trauma or suicide behavior. CBT might be particularly efficient in individuals wishing to reintegrate premorbide functioning and those with low duration of untreated psychosis. Despite these encouraging results, psychosis orientated CBT are underused in France. The validation of group CBT specifically designed for FEP should enhance the range of patients receiving this treatment. Moreover, early CBT interventions for people at ultra high-risk for psychosis and assertive community treatments should be developed.

Development and preliminary validation of the First Episode Social Functioning Scale for early psychosis

The current study aimed at developing and conducting a preliminary validation a novel social functioning measure for people with early psychosis. The First Episode Social Functioning Scale (FESFS) was developed to cover many domains specific to this population in their contemporary reality. The self-report version of the FESFS was administered to 203 individuals receiving services in first episode clinics. Scores of the GAF, SOFAS, Social Functioning Scale and BPRS were also obtained for parts of the sample to calculate convergent and discriminant validity. A subgroup also answered the FESFS at several time points during treatment in order to determine sensibility to change. Principal component factor analyses and internal consistency analyses revealed the following nine factors with alphas ranging from 0.63 to 0.80: Friendships and social activities, Independent living skills, Interacting with people, Family, Intimacy, Relationships and social activities at work, Work abilities, Relationships and social activities at school, Educational abilities. Convergent and discriminant validity were demonstrated, as well as sensitivity to change. Clinical and research utility of the FESFS are discussed.

[Evidence-based interventions in psychiatric rehabilitation: which ones should we prioritized and why?]

OBJECTIVE

This critical literature review describes current evidence-based psychiatric rehabilitation interventions.

METHOD

A brief description of recent meta-analyses and (or) literature reviews is presented for each targeted intervention, along with their revelance for psychiatric rehabilitation and their limits.

RESULTS

The interventions presented include: family interventions, cognitive-behavioural therapy for psychosis, social skills training, cognitive remediation, integrated treatment for substance misuse and mental disorders, and supported employment programs.

CONCLUSIONS

The psychiatric rehabilitation interventions presented in this article not only are based on empirical evidence but also offer clinical tools support the recovery of people with a severe mental illness.

Cognitive-behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias

BACKGROUND

Cognitive-behavioural therapy (CBT) is considered to be effective for the symptoms of schizophrenia. However, this view is based mainly on meta-analysis, whose findings can be influenced by failure to consider sources of bias.

AIMS

To conduct a systematic review and meta-analysis of the effectiveness of CBT for schizophrenic symptoms that includes an examination of potential sources of bias.

METHOD

Data were pooled from randomised trials providing end-of-study data on overall, positive and negative symptoms. The moderating effects of randomisation, masking of outcome assessments, incompleteness of outcome data and use of a control intervention were examined. Publication bias was also investigated.

RESULTS

Pooled effect sizes were -0.33 (95% CI -0.47 to -0.19) in 34 studies of overall symptoms, -0.25 (95% CI -0.37 to -0.13) in 33 studies of positive symptoms and -0.13 (95% CI -0.25 to -0.01) in 34 studies of negative symptoms. Masking significantly moderated effect size in the meta-analyses of overall symptoms (effect sizes -0.62 (95% CI -0.88 to -0.35) v. -0.15 (95% CI -0.27 to -0.03), P = 0.001) and positive symptoms (effect sizes -0.57 (95% CI -0.76 to -0.39) v. -0.08 (95% CI -0.18 to 0.03), P<0.001). Use of a control intervention did not moderate effect size in any of the analyses. There was no consistent evidence of publication bias across different analyses.

CONCLUSIONS

Cognitive-behavioural therapy has a therapeutic effect on schizophrenic symptoms in the 'small' range. This reduces further when sources of bias, particularly masking, are controlled for.

Psychosocial treatments for negative symptoms in schizophrenia: current practices and future directions

Schizophrenia can be a chronic and debilitating psychiatric disorder. Though advancements have been made in the psychosocial treatment of some symptoms of schizophrenia, people with schizophrenia often continue to experience some level of symptoms, particularly negative symptoms, throughout their lives. Because negative symptoms are associated with poor functioning and quality of life, the treatment of negative symptoms is a high priority for intervention development. However, current psychosocial treatments primarily focus on the reduction of positive symptoms with comparatively few studies investigating the efficacy of psychosocial treatments for negative symptoms. In this article, we review and evaluate the existing literature on three categories of psychosocial treatments--cognitive behavioral therapy (CBT), social skills training (SST), and combined treatment interventions--and their impact on the negative symptoms of schizophrenia. Of the interventions reviewed, CBT and SST appear to have the most empirical support, with some evidence suggesting that CBT is associated with maintenance of negative symptom improvement beyond six months after treatment. It remains unclear if a combined treatment approach provides improvements above and beyond those associated with each individual treatment modality. Although psychosocial treatments show promise for the treatment of negative symptoms, there are many unanswered questions about how best to intervene. We conclude with a general discussion of these unanswered questions, future directions and methodological considerations, and suggestions for the further development of negative symptom interventions.

Cognitive-behavioural therapy for schizophrenia: a critical commentary on the Newton-Howes and Wood meta-analysis

Newton-Howes and Wood (published online, this journal, 8 Dec 2011) report the results of their systematic review and meta-analysis of clinical trials of cognitive-behavioural therapy (CBT) for schizophrenia. They ran a random effects analysis of endpoint data from trials where participants were randomly allocated to receive either CBT or a control therapy, which could be inactive (e.g., befriending) or active (e.g., analytic supportive psychotherapy), found no difference between the groups and concluded 'it (CBT) does not outperform supportive therapy in effecting change in phenomenology.' Such a conclusion is premature, if not unwarranted, for a number of reasons, including basic mistakes, lack of transparency, and failure to consider dose.

Pilot programme of modular symptom-specific group cognitive behaviour therapy in a 'Real World' early intervention in psychosis service

AIM

A modular symptom-specific (MSS) programme of early intervention group cognitive behaviour therapy for psychosis might confer additional therapeutic benefits and clinical and financial efficiency, but the approach is empirically untested. Therefore, we devised a novel MSS programme to test - in a culturally diverse 'Real World' early intervention service - its relevancy, feasibility, acceptability and safety.

METHOD

The MSS programme comprised six different groups across 33 sessions: Psycho-Education (3), Mood-Management (5), Delusions (8), Auditory Hallucinations (8), Past Auditory Hallucinations (3) and Negative Symptoms (6). All patients were eligible for psycho-education, but other groups required a specific symptom.

RESULTS

Patients (n = 166, 37% White) showed wide heterogeneity in the activity, type and number of symptoms, and group-relevant symptoms were common. Eighteen groups have run so far, each type of group at least once, 58/166 (35%) of patients attended across 281/412 (68%) group sessions, 46/58 (79%) of patients re-attended, and the 58 patients attended groups a mean of 4.8 times. Patients were significantly (P < 0.05) more likely to attend the programme if they had a schizophrenia diagnosis, a longer psychotic illness length or one active group-relevant (psychotic/mood) symptom. Diagnostically uncertain psychosis patients were almost significantly (P = 0.05) less likely to attend the programme. duration of untreated psychosis and ethnicity were unrelated to attendance/re-attendance. No group-related risk incidents occurred.

CONCLUSION

A MSS programme approach is highly relevant to early intervention symptom heterogeneity and is feasible, culturally acceptable and safe; it also appears particularly efficient. Future research should now test its clinical efficacy.

Do personality traits matter when choosing a group therapy for early psychosis?

OBJECTIVES

This study aimed at determining the predictive value of personality traits, based on the Five Factor Model (FFM) of personality, on therapeutic outcomes according to specific group treatments for first episode psychosis: cognitive-behavioural therapy (CBT) or skills training for symptom management (SM).

METHODS

Individuals experiencing early psychosis were recruited to participate in a randomized- controlled trial (RCT). Participants were randomized to one of two group treatments or to a wait-list control group. Measures included a personality inventory (NEO-FFI) and outcome measures of symptomatology (BPRS-E) and coping strategies (CCS). Pearson correlation analyses were conducted on 78 individuals and linear regression analyses on 66.

RESULTS

Links were found between personality traits, symptoms, and coping outcome measures, according to specific group treatments. Personality traits were particularly linked to therapeutic changes in active coping strategies, with Conscientiousness accounting for 14% of the variance in the CBT group, Extraversion accounting for 41% of the variance in the SM group, and Openness to experience accounting for 22% of the variance in the control group.

CONCLUSIONS

Individual differences in personality traits for people experiencing early psychosis should be considered when offering psychosocial treatments, since it appears that those with specific traits might benefit more than others in specific group interventions, particularly for interventions that do not solely aim at improving symptoms.

Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care

Schizophrenia is a disabling psychiatric illness associated with disruptions in cognition, emotion, and psychosocial and occupational functioning. Increasing evidence shows that psychosocial interventions for people with schizophrenia, as an adjunct to medications or usual psychiatric care, can reduce psychotic symptoms and relapse and improve patients' long-term outcomes such as recovery, remission, and illness progression. This critical review of the literature was conducted to identify the common approaches to psychosocial interventions for people with schizophrenia. Treatment planning and outcomes were also explored and discussed to better understand the effects of these interventions in terms of person-focused perspectives such as their perceived quality of life and satisfaction and their acceptability and adherence to treatments or services received. We searched major health care databases such as EMBASE, MEDLINE, and PsycLIT and identified relevant literature in English from these databases. Their reference lists were screened, and studies were selected if they met the criteria of using a randomized controlled trial or systematic review design, giving a clear description of the interventions used, and having a study sample of people primarily diagnosed with schizophrenia. Five main approaches to psychosocial intervention had been used for the treatment of schizophrenia: cognitive therapy (cognitive behavioral and cognitive remediation therapy), psychoeducation, family intervention, social skills training, and assertive community treatment. Most of these five approaches applied to people with schizophrenia have demonstrated satisfactory levels of short- to medium-term clinical efficacy in terms of symptom control or reduction, level of functioning, and/or relapse rate. However, the comparative effects between these five approaches have not been well studied; thus, we are not able to clearly understand the superiority of any of these interventions. With the exception of patient relapse, the longer-term (eg, >2 years) effects of these approaches on most psychosocial outcomes are not well-established among these patients. Despite the fact that patients' perspectives on treatment and care have been increasingly concerned, not many studies have evaluated the effect of interventions on this perspective, and where they did, the findings were inconclusive. To conclude, current approaches to psychosocial interventions for schizophrenia have their strengths and weaknesses, particularly indicating limited evidence on long-term effects. To improve the longer-term outcomes of people with schizophrenia, future treatment strategies should focus on risk identification, early intervention, person-focused therapy, partnership with family caregivers, and the integration of evidence-based psychosocial interventions into existing services.

Group CBT for early psychosis--are there still benefits one year later?

Our team recently conducted a randomized controlled trial comparing group cognitive behavior therapy for psychosis (CBTp) to group social skills training for symptom management and a wait-list control group, for early psychosis. The results at post-therapy and six months provided considerable empirical support for the efficacy of the group CBTp. The results of the one-year follow-up are described here. Given the high attrition rates, mostly in the comparison and control conditions, imputations were not possible, so that only the results of those having completed more than 50% of the group CBTp are presented. Significant improvements at 12 months were found for social support and insight. Negative symptoms remained low, whereas positive symptoms went back to pre-therapy levels. Challenges regarding attrition with this clientele are discussed.

Social functioning in early psychosis: are all the domains predicted by the same variables?

AIM

The study aims to determine the predictive value of negative symptoms, depression, short-term verbal learning and gender on three areas of social functioning--social life, vocational functioning and independent living skills--in a sample of 88 individuals with early psychosis.

METHODS

Participants were recruited from early psychosis intervention programmes and community mental health clinics in British Columbia, Canada, and completed the following measures: client's assessment of strengths, interests, and goals, brief psychiatric rating scale, Beck depression inventory and California verbal learning task.

RESULTS

Multiple linear regressions revealed that: more negative symptoms and higher depression predicted a less active social life; more negative symptoms and poorer short-term verbal learning ability predicted lower vocational functioning; and more negative symptoms and male gender predicted lower independent living skills.

CONCLUSION

Results suggest that negative symptoms are predictive of all three areas of functioning but that specific variables add significant unique variance to individual areas of social functioning. Although a global social functioning score can be considered useful, greater precision can be gained by the use of domain-specific measures.

Assessing fidelity to integrated motivational interviewing and CBT therapy for psychosis and substance use: the MI-CBT fidelity scale (MI-CTS)

BACKGROUND

Guidelines for the psychological treatment of psychosis and substance use suggest integrated treatments to address both problems are necessary. One such treatment combines cognitive-behaviour therapy (CBT) and motivational interviewing (MI). While there are a number of scales to assess treatment fidelity to CBT and MI separately, none, to date, assess fidelity to integrated MI and CBT (MI-CBT) for psychosis and substance use.

AIMS

This study aimed to develop a reliable and valid scale to assess fidelity to MI-CBT for people with psychosis and problematic substance use.

METHOD

Items for a new scale (the MI-CTS fidelity scale) were selected from multiple relevant sources. Inter-rater reliability and validity (against the CTS-Psy and Motivational Interviewing Treatment Integrity (MITI)) scales were investigated.

RESULTS

The scale had good inter-rater reliability when used to rate adherence versus non-adherence. In relation to validity, the scale related well to CBT and MI scales (the CTS-Psy and MITI).

CONCLUSIONS

The MI-CTS is useful for assessing adherence to integrated MI-CBT for psychosis and substance misuse and could aid training and implementation of the approach.

Cognitive behaviour therapy for schizophrenia

Schizophrenia is one of the major and potentially severe mental illnesses. Even with best practices, there are limitations to the effectiveness of treatments that include medications for this disorder. Relapse rates are high and often those with the illness remain symptomatic and functionally impaired. All the evidence suggests that individuals with schizophrenia do best with a combination of pharmacological and psychosocial intervention. One psychosocial treatment that has received much attention is cognitive behaviour therapy (CBT). This brief review will address what we know about the use and effectiveness of CBT at all phases of schizophrenia and its strengths, weaknesses and its future.

Cognitive behavior therapy for schizophrenia: a meta-analytical review of randomized controlled trials

BACKGROUND

In the UK and in Sweden, cognitive behavior therapy (CBT) has been recommended for schizophrenia. The two recent meta-analyses examined results soon after treatment and not at follow-up.

AIM

To determine the effectiveness of CBT in people with schizophrenia, both after treatment and at follow-up, and to compare it with treatment as usual (TAU) and other psychological treatments.

METHODS

The search was carried in the databases CENTRAL (Cochrane Central Register of Controlled Trials), PsycINFO and PubMed (Medline). Inclusion criteria were randomized controlled trials (RCTs) with low risk of bias. Two reviewers, working independently, extracted data. The results were analyzed using risk ratio (RR), risk difference (RD), mean difference (MD), or standardized mean difference (SMD). Outcome measures were symptoms, use of medication, relapse and clinically important improvement.

RESULTS

When CBT was compared with other psychological treatments at follow-up, there was strong evidence (with small treatment effect) that intervention has an effect with positive symptoms (P = 0.02), negative symptoms (P = 0.03) and general symptoms (P = 0.003). After treatment, there was a trend in favor of CBT, but not statistically significantly so.

CONCLUSION

It appears that the effect of CBT is delayed; it could be seen a few months after the treatment had terminated. Therapies for patients with schizophrenia that were 20 sessions long or more had better outcomes than those that were shorter.

"Michael's Game," a card game for the treatment of psychotic symptoms

OBJECTIVE

"Michael's Game" is a card game which aims at familiarizing healthcare professionals and patients with cognitive therapy of psychotic symptoms. The present study tests the feasibility and the impact of the intervention in naturalistic settings.

METHODS

135 patients were recruited in 11 centres. They were assessed pre- and post-tests with the Beck Cognitive Insight Scale (BCIS) and the Peters Delusion Inventory-21 items (PDI-21).

RESULTS

Data about 107 patients were included in the entire analyses. Significant improvements were observed on BCIS subscales as well as a reduction of severity of conviction and preoccupation scores on the PDI-21. The intervention has a moderate effect on the PDI-21 preoccupation and conviction as well as the BCIS subscales. Patients who benefit the most from the program are patients who have a low degree of self-reflectiveness and patients who are concomitantly preoccupied by their symptoms.

CONCLUSION

The present study supports the feasibility and effectiveness of "Michael's Game" in naturalistic settings.

PRACTICAL IMPLICATIONS

The game seems to be a useful tool for patients with psychotic disorders.

Group cognitive behavioural therapy as a treatment for negative symptoms in first-episode psychosis

AIM

We aimed to test the idea that there is an early critical time period during a psychotic illness when patients may be more responsive to psychological treatment attention.

METHODS

We tested this hypothesis by comparing the treatment responsiveness to group cognitive behavioural therapy (CBT) of 25 first-episode psychosis participants (FEP) and 15 patients with currently stable psychosis (n = 40).

RESULTS

Following 12 sessions of outpatient-based group CBT, there were significant decreases in positive, depressive and anxiety symptoms, and an improvement in quality of life for both groups. However, negative symptoms only improved in the FEP group.

CONCLUSION

Considering the pernicious nature of negative symptoms as well as the difficulties in treating them, this study provides some support for the concept of early intervention with CBT.

A review of hearing voices groups: evidence and mechanisms of change

As a heavily stigmatized group, voice hearers often value the chance to meet others with similar experiences. As a result, Hearing Voices Groups (HVGs) are becoming increasingly common in both inpatient and outpatient settings. Where resources are constrained, HVGs are frequently viewed as a desirable alternative to individual therapy and are often preferred by service users themselves. HVGs often vary in their content and structure, with four common approaches: CBT, skills-training, mindfulness and unstructured support groups. This review evaluates the evidence for HVGs and the mechanisms of change for successful interventions. CBT was the only approach with evidence from well-controlled studies. However, several evidence-based treatments share 'key ingredients' which evidence suggests help reduce distress. Successful groups supply a safe context for participants to share experiences, and enable dissemination of strategies for coping with voices as well as considering alternative beliefs about voices. Future research should focus on isolating mechanisms of change and predictors of outcome in order to refine HVG approaches, rather than polarizing them and setting them against one another in efficacy trials.

Personality traits in early psychosis: relationship with symptom and coping treatment outcomes

AIMS

This study aimed to determine personality profiles of individuals with early psychosis based on the Five Factor Model of personality and assess the predictive value of personality traits or profiles on therapeutic outcomes of two group treatments for recent onset psychosis: cognitive behaviour therapy or skills training for symptom management.

METHODS

One hundred and twenty-nine individuals with early psychosis were recruited to participate in a randomized controlled trial. The participants were randomized to one of two group treatments or to a wait-list control group. Measures included a personality inventory (NEO Five Factor Inventory) and outcome measures of symptomatology (Brief Psychiatric Rating Scale-Expanded) and coping strategies (Cybernetic Coping Scale).

RESULTS

Cluster analyses revealed three different personality profiles (based on the Five Factor Model) - none specifically linked to psychotic symptoms. No links were revealed between personality traits and symptom change scores. Personality traits were linked to therapeutic improvements in active coping strategies, with extraversion accounting for 17% of the variance. Neuroticism was linked to increased use of passive coping strategies. Active coping strategies were also predicted by profile 1 (holding the highest openness score) with 26% of the variance explained and by profile 3 (the highest extraversion score), with 14% of the variance explained.

CONCLUSIONS

Individuals with early psychosis can present with distinct personality profiles as would be expected in a non-clinical population. Personality traits do not appear to influence symptomatic treatment outcomes but are linked to behavioural changes, such as the use of coping strategies.

A pilot investigation of the Graduated Recovery Intervention Program (GRIP) for first episode psychosis

The Graduated Recovery Intervention Program (GRIP) is a new individual cognitive-behavioral therapy program designed to facilitate functional recovery in people who have experienced an initial episode of psychosis. The purposes of this study were to evaluate the feasibility and tolerability of the GRIP intervention, and to compare the effectiveness of GRIP versus treatment as usual (TAU) for improving specific clinical and psychosocial outcomes. Forty-six individuals with first episode psychosis were randomized to GRIP+TAU or TAU alone. Primary outcomes focused on social and role functioning, and quality of life. Secondary outcomes included psychotic symptoms, depression, substance use, social support, attitudes toward medications, well-being, and hospitalizations. The results indicate that GRIP was well-tolerated, as evidenced by good attendance and low drop-out rates, and well-received (based on positive feedback from participants). Although the majority of mixed model analyses were not statistically significant, examination of within-group changes and effect sizes suggests an advantage for GRIP over TAU in improving functional outcomes. These advantages and the fact that the GRIP intervention demonstrated feasibility and tolerability suggest that this intervention is worthy of further investigation.

Early intervention services, cognitive-behavioural therapy and family intervention in early psychosis: systematic review

BACKGROUND

Early intervention services for psychosis aim to detect emergent symptoms, reduce the duration of untreated psychosis, and improve access to effective treatments.

AIMS

To evaluate the effectiveness of early intervention services, cognitive-behavioural therapy (CBT) and family intervention in early psychosis.

METHOD

Systematic review and meta-analysis of randomised controlled trials of early intervention services, CBT and family intervention for people with early psychosis.

RESULTS

Early intervention services reduced hospital admission, relapse rates and symptom severity, and improved access to and engagement with treatment. Used alone, family intervention reduced relapse and hospital admission rates, whereas CBT reduced the severity of symptoms with little impact on relapse or hospital admission.

CONCLUSIONS

For people with early psychosis, early intervention services appear to have clinically important benefits over standard care. Including CBT and family intervention within the service may contribute to improved outcomes in this critical period. The longer-term benefits of this approach and its component treatments for people with early and established psychosis need further research.

Cognitive-behaviour therapy for medication-resistant positive symptoms in early psychosis: a case series

INTRODUCTION

Cognitive-behaviour therapy (CBT) for psychosis reduces the severity of medication-resistant positive symptoms in chronic schizophrenia, but its efficacy for early psychosis outpatients with a similar profile has not been established.

OBJECTIVE

This paper describes an uncontrolled evaluation of CBT, added to medication and comprehensive care in an early psychosis program, in a group of stable outpatients.

PATIENTS

The sample was drawn from 24 consecutive referrals. Fourteen were eligible, i.e. had positive symptom(s) and had been on the same medication regime for 3 months.

TREATMENT

Patients received an average of 16 individual sessions with a senior psychologist.

MEASURES

Symptom severity was assessed both by an independent rater, and by patient self-report.

RESULTS

Eleven of 14 patients completed treatment. Both clinician and self-report post-treatment ratings of positive symptoms were significantly reduced following CBT. For positive symptom totals, effect sizes ranged from d = 1.0 to 1.3. Clinically significant changes were apparent in at least eight of 11 patients.

DISCUSSION

While case-series studies have significant limitations, the large effect sizes described here suggest that CBT shows promise for effectiveness with early psychosis patients. A randomized trial is needed to establish both the effect size over and above a control condition, and the durability of gains of CBT for medication-resistant symptoms in early psychosis.

Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials

BACKGROUND

Although cognitive behavioural therapy (CBT) is claimed to be effective in schizophrenia, major depression and bipolar disorder, there have been negative findings in well-conducted studies and meta-analyses have not fully considered the potential influence of blindness or the use of control interventions.

METHOD

We pooled data from published trials of CBT in schizophrenia, major depression and bipolar disorder that used controls for non-specific effects of intervention. Trials of effectiveness against relapse were also pooled, including those that compared CBT to treatment as usual (TAU). Blinding was examined as a moderating factor.

RESULTS

CBT was not effective in reducing symptoms in schizophrenia or in preventing relapse. CBT was effective in reducing symptoms in major depression, although the effect size was small, and in reducing relapse. CBT was ineffective in reducing relapse in bipolar disorder.

CONCLUSIONS

CBT is no better than non-specific control interventions in the treatment of schizophrenia and does not reduce relapse rates. It is effective in major depression but the size of the effect is small in treatment studies. On present evidence CBT is not an effective treatment strategy for prevention of relapse in bipolar disorder.

Change in delusions is associated with change in "jumping to conclusions"

Evidence has been put forward that premature termination of data collection and jumping to conclusions behavior (JTC) is associated with delusions. However, few investigations have attempted to track associations between changes in delusions and changes in JTC measures. In the current study individuals with schizophrenia spectrum disorders completed a version of the JTC task (involving fishing from lakes as opposed to drawing beads from a jar) at two timepoints 12 weeks apart. The results revealed significant negative correlations between change in task performance (number of requested pieces of information) and change in delusion scores over time. This evidence is consistent with the contention that the JTC task is sensitive to the cognitive systems underlying delusions in schizophrenia spectrum disorders.